Journal of endourology最新文献

{"title":"Impact of Patient Factors on Robotic-Assisted Partial Nephrectomy Operating Room Times: The Case for Fixed Operating Room Time as a Viable Efficiency Target.","authors":"Neda Qosja, Laura E Geldmaker, Christopher H Hasse, Vartika Tiwari, Taylor R Fuqua, Daniela A Haehn, Colleen S Thomas, Alex Hochwald, David D Thiel","doi":"10.1089/end.2024.0330","DOIUrl":"10.1089/end.2024.0330","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> To analyze the association of patient characteristics on operating room (OR) times for robotic-assisted partial nephrectomies (RAPNs). <b><i>Methods:</i></b> In total, 248 consecutive RAPNs were performed by a single surgeon from October 2018 to August 2022. Data were collected on the following patient factors: sex, age, race, weight, body mass index (BMI), diabetes, hypertension (HTN), tumor side, tumor mass, and American Society of Anesthesiologists (ASA) score. Total fixed OR times were evaluated as the sum of in-room time to anesthesia-release time (IRAT), anesthesia-release time to cut time (ARCT), close time to wheels out time (CTWO), and in-room time to cut time (IRAT + ARCT). Total variable OR times were defined as cut time to close time (CTCT). Total operative time was defined as wheels into wheel out (WIWO). <b><i>Results:</i></b> Median OR time was 265 minutes (interquartile range [IQR]: 247-298 minutes) for WIWO, 191 minutes (IQR: 170-225 minutes) for CTCT, and 75 minutes (IQR: 68-83 minutes) for total fixed time. There was a significant increase in WIWO with the following patient variables: male sex (18.0 minutes, 95% confidence interval [CI]: 6.3-29.7 minutes), weight (5.6 minutes, 95% CI: 2.8-8.4 minutes), BMI (14.3 minutes, 95% CI: 4.2-24.4 minutes), HTN (15.1 minutes, 95% CI: 3.7-26.5 minutes), pathology tumor size (cm) (6.4 minutes, 95% CI: 2.2-10.6 minutes), and ASA score (13.8 minutes, 95% CI: 3.1-24.4 minutes). Sex, age, BMI, weight, HTN, and pathology tumor size significantly impacted CTCT (<i>P</i> < 0.05). Total fixed OR time was only affected by ASA score (<i>P</i> = 0.02). <b><i>Conclusions:</i></b> Patient variables significantly affect total OR time and variable OR time. These variables do not impact total fixed OR times, confirming fixed OR time as a viable OR efficiency point.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"121-126"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Segmental Resection with Ureteral Reimplantation <i>vs</i> Radical Nephroureterectomy with Bladder Cuff Removal for Urothelial Carcinoma of Distal Ureter: A Propensity Score Matching Study in a Large Chinese Center.","authors":"Bao Guan, Yiwei Huang, Guoli Wang, Huifeng Zhang, Zihao Tao, Qi Tang, Chunru Xu, Qian Yang, Hanzhen Ren, Yicong Du, Chao Cao, Kaishun Luo, Kai Zhang, Liqun Zhou, Xuesong Li","doi":"10.1089/end.2024.0654","DOIUrl":"10.1089/end.2024.0654","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> We aim to compare the clinical outcomes of radical nephroureterectomy with bladder cuff removal (RNU) and segmental resection with ureteral reimplantation (RR) in Chinese patients with distal ureteral urothelial carcinoma. <b><i>Materials and Methods:</i></b> A retrospective analysis of medical records was performed for 922 patients found to have distal ureteral cancer, defined as below the level of the iliac vessels, with 747 patients who underwent RNU and 175 who underwent RR included in the final analysis. The primary endpoints included clinical outcomes and changes in the estimated glomerular filtration rate (eGFR). Survival analysis was conducted using the Kaplan-Meier method, and propensity score matching (PSM) was utilized to mitigate selection bias between the two surgical approaches. <b><i>Results:</i></b> After PSM, the Kaplan-Meier survival curves demonstrated significant associations between surgical approach and both local recurrence-free survival (LRFS) and bladder recurrence-free survival (BRFS), but no significant differences were found in cancer-specific survival (CSS) and overall survival (OS). There were no significant differences in metastasis-free survival and contralateral recurrence-free survival between the two groups. Multivariate Cox regression analysis identified RR as an independent predictor of poorer outcomes for LRFS and BRFS. In addition, a significant increase in eGFR was observed following RR, whereas a significant decrease was noted after RNU. <b><i>Conclusion:</i></b> RR is associated with equivalent CSS and OS compared with RNU, even in the context of high-risk distal ureteral cancer, and results in improved postoperative eGFR, whereas the potential of RR to increase the risk of local tumor recurrence and intravesical recurrence requires clinical consideration.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"105-113"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dr. Michael A. Palese, MD.","authors":"","doi":"10.1089/end.2025.21556.spot","DOIUrl":"10.1089/end.2025.21556.spot","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"93"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Feasibility Study on the Efficacy and Safety of a Novel Tip-Flexible Suction Ureteral Access Sheath Combined with Flexible Ureteroscopic Lithotripsy for Treating Kidney Stones ≥30 mm.","authors":"Wenwei Chen, Kaixin Lu, Changyi Liu, Jinfeng Weng, Rui Gao","doi":"10.1089/end.2024.0283","DOIUrl":"10.1089/end.2024.0283","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To evaluate the efficacy and safety of a novel tip-flexible suction ureteral access sheath (NTFS-UAS) combined with flexible ureteroscopic lithotripsy (FURS) for treating kidney stones ≥30 mm in a large cohort. <b><i>Methods:</i></b> The clinical data of 206 patients with renal calculi ≥30 mm treated by NTFS-UAS combined with FURS from June 2021 to September 2023 were analyzed retrospectively. The outcomes under investigation encompassed demographic information, stone-related characteristics, operative time, stone-free rates (SFRs), and postoperative complications. <b><i>Results:</i></b> The median operation duration was 110 minutes (interquartile 84.00-146.25 minutes). Immediate and 1-month SFRs were 83.98% and 85.44%, respectively. Multivariate analysis revealed five risk factors independently affecting stone clearance rate: stone size (≥50 mm, odds ratio [OR] = 3.826, <i>p</i> = 0.039), stone number (multiple: OR = 8.745, <i>p</i> = 0.015), stone location (multiple calyces: OR = 10.371, <i>p</i> = 0.045; lower calyx: OR = 9.615, <i>p</i> = 0.047), severe hydronephrosis (OR = 8.338, <i>p</i> = 0.002), and the Resorlu-Unsal scoring system (RUSS) score (6-7: OR = 10.829, <i>p</i> = 0.009; 4-5: OR = 4.223, <i>p</i> = 0.008). The incidence of Clavien-Dindo grade II-III complication was 5.82%. Positive preoperative urine culture (OR = 9.533, <i>p</i> = 0.012) and RUSS score (6-7: OR = 25.678, <i>p</i> = 0.026; 4-5: OR = 11.444, <i>p</i> = 0.038) were identified as the most important variables that may contribute to the development of high-grade postoperative complications. <b><i>Conclusion:</i></b> NFTS-UAS combined with FURS achieved satisfactory outcomes with good efficacy and safety for treating large renal stones ≥30 mm, and it can be utilized as an effective treatment option for patients having contraindications or preference against percutaneous nephrolithotomy. In addition, clinical factors, such as stone size, severe hydronephrosis, positive preoperative urine culture, and RUSS stone score that likely affected the outcomes of NFTS-UAS, should be fully taken into account when the surgeon performing FURS using NFTS-UAS.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"135-145"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-Hospital Outcomes after Robotic <i>Vs</i> Open Radical Nephroureterectomy.","authors":"Francesco Di Bello, Natali Rodriguez Peñaranda, Andrea Marmiroli, Mattia Longoni, Fabian Falkenbach, Quynh Chi Le, Zhe Tian, Jordan A Goyal, Claudia Collà Ruvolo, Gianluigi Califano, Massimiliano Creta, Fred Saad, Shahrokh F Shariat, Stefano Puliatti, Ottavio De Cobelli, Alberto Briganti, Markus Graefen, Felix H K Chun, Nicola Longo, Pierre I Karakiewicz","doi":"10.1089/end.2024.0730","DOIUrl":"10.1089/end.2024.0730","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To test whether the contemporary robot-assisted nephroureterectomy (RNU) is associated with more favorable in-hospital outcomes than historical RNU, relative to the same endpoints in open NU (ONU). <b><i>Methods:</i></b> Within the National Inpatient Sample (2008-2019), we identified RNU and ONU patients. Multivariable logistic and Poisson regression models were fitted. <b><i>Results:</i></b> Of 8032 NU patients, historical (2008-2013) <i>vs</i> contemporary (2014-2019) proportions were 776 (41%) <i>vs</i> 1104 (59%) for RNU and 3719 (60%) <i>vs</i> 2433 (40%) for ONU. The rates of RNU have increased over time (2008-2019; Δ absolute: +18%; <i>p</i> < 0.001). Contemporary RNU patients exhibited significantly better in-hospital outcomes in 6 of 12 comparisons <i>vs</i> historical that ranged from -54% for genitourinary complications to -12% for median length of stay (LOS). Contemporary ONU patients also exhibited significantly better in-hospital outcomes in 11 of 12 comparisons <i>vs</i> historical that ranged from -67% for blood transfusions to -26% for gastrointestinal complications. When historical RNU was compared with historical ONU, RNU in-hospital outcomes were better in 7 of 12 comparisons that ranged from -61% for median LOS to -16% for postoperative complications. Conversely, when contemporary RNU was compared with contemporary ONU, RNU in-hospital outcomes were only better in 2 of 12 comparisons: -25% cardiac complications and -13% for median LOS. <b><i>Conclusion:</i></b> The magnitude of in-hospital outcomes categories improvement between historical <i>vs</i> contemporary was two-fold more pronounced in ONU (11 improved categories) than in RNU (6 improved categories). Few outcome benefits remained (two categories only) when contemporary RNU was compared with contemporary ONU.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"127-134"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ureteroureterostomy for the Management of Non-Neoplastic Distal Ureteral Lesions: A New Challenger of Care in the Era of Robotic Surgery?","authors":"Eleonora Rosato, Roberto Miano, Antonio Pastore, Andrea Fuschi, Luca Orecchia, Thierry Piechaud, Richard Gaston, Anastasios D Asimakopoulos","doi":"10.1089/end.2024.0735","DOIUrl":"10.1089/end.2024.0735","url":null,"abstract":"<p><p><b><i>Background:</i></b> Iatrogenic lesions of the distal ureter represent a frequent and feared complication of abdominal surgery that is traditionally managed by ureteral reimplantation. The aim of this systematic review (SR) is to summarize the published literature on the role of minimally invasive ureteroureterostomy (UU) in the surgical treatment of non-neoplastic distal ureteral lesions. <b><i>Methods:</i></b> We performed a comprehensive literature search on PubMed, Embase, and Cochrane CENTRAL including published peer-reviewed studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The intra-, peri-, and postoperative outcomes as well as the safety profile and the success rates of minimally invasive UU are presented. <b><i>Results:</i></b> Seven retrospective studies with 116 patients were included in this SR. If the basic principles of the ureteral reconstructive procedure are followed, both laparoscopic and robotic UU are feasible, safe, and with a success rate ranging between 81.8% and 100%, depending on the definition of success. A single comparative study documented a significant difference in operative time and length of hospitalization in favor of robotic UU. The success of both laparoscopic and robotic UU has been mainly evaluated in the short and intermediate follow-up. <b><i>Conclusion:</i></b> Minimally invasive UU may represent a viable treatment option for the treatment of non-neoplastic distal ureter pathology such as iatrogenic injuries or radiotherapy-induced stenosis. Larger, prospective studies adopting a standard definition of the postoperative success are required to affirm UU as a first-line option in the management of benign distal ureteral lesions.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"157-165"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of Ultrasonography-Guided Percutaneous Nephrolithotomy for the Management of Pediatric Urolithiasis.","authors":"Yang Hong, Luping Yu, Xiaobo Huang, Lizhe An, Liulin Xiong, Tao Xu, QingQuan Xu","doi":"10.1089/end.2023.0771","DOIUrl":"10.1089/end.2023.0771","url":null,"abstract":"<p><p><b><i>Objectives:</i></b> This study aims to assess the outcomes of ultrasonography (US)-guided minimally invasive percutaneous nephrolithotomy (PCNL) in the treatment of pediatric urolithiasis. <b><i>Methods:</i></b> A retrospective analysis was conducted on 176 patients with pediatric renal and upper ureteral lithotripsy who underwent PCNL between August 2006 and July 2022. The cohort comprised 110 men and 66 women, with ages ranging from 6 months to 16 years. Postoperative stone clearance was evaluated using kidney, ureter, and bladder radiograph or US, categorizing stones less than 4 mm as clear. Postoperative complications were graded according to the Clavien-Dindo classification, with grades I and II considered minor and III and IV classified as major. <b><i>Results:</i></b> Among the patients, 152 underwent unilateral renal operation, whereas 24 underwent bilateral renal operation. The average operation duration was 67.41 minutes (range: 15-195 minutes). The mean duration of nephrostomy tube removal was 3.79 days, and the mean postsurgical hospital stay was 5.97 days. A total of 146 patients experienced a decrease in hemoglobin concentration post operation, with an average drop of 10.57 g/dL (range: 0.5-37.8 g/dL). Initial stone-free rate (SFR) was achieved in 85.5% (171/200) of cases, and the final SFR was 92.50% (185/200). The postoperative rate of minor complications was 8.54% (17/199), whereas major complications occurred in 12.06% (24/199) of cases. During the 6-month to 11-year follow-up period, 19 patients presented with combined stones, and of these 4 presented with ipsilateral stone recurrence who underwent PCNL treatment. Calcium oxalate was identified as the most common stone component. <b><i>Conclusions:</i></b> US-guided minimally invasive PCNL demonstrated excellent SFR and an acceptable complication rate in the management of pediatric urolithiasis. Furthermore, it offers the advantage of minimizing potential risks associated with radiation exposure during the procedure.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"146-150"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No Injury Observed in Kidneys Treated with Burst Wave Lithotripsy in Therapeutically Anticoagulated Pigs.","authors":"Thomas M Shelton, Bret A Connors, Marcelino E Rivera, James E Lingeman, Michael R Bailey, James C Williams","doi":"10.1089/end.2024.0466","DOIUrl":"https://doi.org/10.1089/end.2024.0466","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Current American Urological Association guidelines recommend that patients with acute obstructive kidney stone requiring continuous anticoagulation/antiplatelet therapy should not be treated by shockwave lithotripsy or percutaneous nephrolithotomy because of the risk of catastrophic renal hemorrhage possible with those techniques. Currently, ureteroscopy is the only recommended surgical treatment. We evaluated if burst wave lithotripsy (BWL) could be used in these cases by treating pigs with BWL while undergoing anticoagulation therapy. <b><i>Materials and Methods:</i></b> Six pigs (31-37 kg) were given 200 units/kg porcine heparin, and then the right kidney of each animal was treated with a dose of BWL (18,000 ultrasound pulses at 10 Hz, 20 cycles/pulse, peak positive pressure of 12 MPa) known to fracture kidney stones. The contralateral kidney served as a control. Therapeutic anticoagulation was confirmed by evaluating activated partial thromboplastin time (aPTT). Microhematuria was checked by urine test strips. Kidneys were subsequently evaluated for hemorrhagic injury via MRI. <b><i>Results:</i></b> aPTT was significantly elevated (>100 seconds) throughout the entire treatment period (<i>p</i> = <0.001) indicating therapeutic anticoagulation. Gross hematuria was not observed in any of the pigs. After BWL, microhematuria averaged 145.8 red blood cells (RBC)/μL in the BWL-treated kidney and 48 RBC/μL in the control kidneys, and there was no statistically significant difference noted in microhematuria rates between the two groups (<i>p</i> = 0.16). Hemorrhagic injury measured only 0.10 ± 0.02% of the tissue in the BWL-treated kidneys and 0.12 ± 0.04% in the control side, with a paired difference of -0.03 ± 0.05%, showing no significant difference (<i>p</i> = 0.58). <b><i>Conclusions:</i></b> A typical clinical dose of BWL causes no hemorrhagic injury to the kidney even during therapeutic anticoagulation therapy. This result suggests that BWL should be safe to use in patients with stone undergoing anticoagulation/antiplatelet therapy.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Analysis of Safety and Efficacy Between Anterior and Posterior Calyceal Entry in Supine Percutaneous Nephrolithotomy.","authors":"Anna Ricapito, Kavita Gupta, Ziv Savin, Kasmira R Gupta, Christopher Connors, Raymond Khargi, Alan J Yaghoubian, Blair Gallante, William M Atallah, Mantu Gupta","doi":"10.1089/end.2024.0508","DOIUrl":"10.1089/end.2024.0508","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> One advantage of supine percutaneous nephrolithotomy (sPCNL) is the ability to access anterior as well as posterior calyces, but the safety and efficacy of anterior calyceal entry has never been investigated to our knowledge. We prospectively evaluated patients scheduled for sPCNL comparing anterior and posterior calyceal access. <b><i>Materials and Methods:</i></b> After Institutional Review Board approval, we prospectively enrolled 100 consecutive patients undergoing sPCNL from February to September 2023. Primary outcomes included intraoperative complications, blood transfusions, 30-day complication rates, and emergency department (ED) visits or readmissions. Secondary outcomes included stone-free rates (SFR). <b><i>Results:</i></b> Seventy-six patients had anterior calyceal entry and 24 had posterior. No significant differences were found in terms of baseline demographics (age, body mass index), stone characteristics (location, density, complexity), or intraoperative features (operative time, location of access). Safety outcomes, including intraoperative complications (1% <i>vs</i> 4%), blood transfusions (3% <i>vs</i> 8%), 30-day complication rates (17% <i>vs</i> 21%), and ED visits (1% <i>vs</i> 0) or readmissions (11% <i>vs</i> 21%) were comparable between groups. Overall SFRs were equivalent (86% <i>vs</i> 90%). <b><i>Conclusion:</i></b> We found that anterior and posterior accesses in sPCNL offer similar safety and efficacy, with no significant differences in complications or SFRs. Surgeons can select either approach based on patient anatomy and surgical needs without concern for increased complications. Further research is necessary to confirm these findings and guide best practices for calyx selection in sPCNL.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"19-25"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal Pelvis Urine Sampling in Patients with Obstructed, Infected Ureterolithiasis: A Retrospective Quality Improvement Initiative.","authors":"Majid Mirzazadeh, Raymond Xu, Collette O'Connor, Parth U Thakker","doi":"10.1089/end.2024.0179","DOIUrl":"10.1089/end.2024.0179","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Patients who present with urinary tract infections secondary to obstructing stones occasionally fail to improve on treatment based on midstream urine culture (MUSCx). Varying microbiomes between the bladder and the renal pelvis may account for this. In this study, we sought to investigate the utility of obtaining a renal pelvis urine culture (RPUCx) at the time of stenting to guide antibiotic treatment prior to definitive stone operation. <b><i>Materials and Methods:</i></b> RPUCx was obtained in 257 patients presenting with obstructive ureteral stones undergoing emergent stenting. Concordance rates of RPUCx to MUSCx and blood cultures were examined. Operative time and infectious complication rates after definitive stone management between the two groups were studied. A comparison of those who received an intraoperative RPUCx with those who did not was carried out. <b><i>Results and Conclusions:</i></b> RPUCx was obtained in patients undergoing emergent stenting from 2018 to -2021; 31% (52/168) of patients had pathogens in the renal pelvis that were absent in the MUSCx. RPUCx had a greater concordance rate with blood culture results compared with MUSCx (95% <i>vs</i> 50%). Drawing RPUCx intraoperatively did not significantly change operative time (15.9 <i>vs</i> 13.6 minutes, <i>p</i> = 0.15). Treatment tailored to RPUCx resulted in lower rates of post-stone management complications (odds ratio 0.26, 95% confidence interval = 0.08-0.83; <i>p</i> = 0.01). RPUCx at the time of stenting can guide treatment and decrease post-treatment complications without additional operative time, confirming utility in the treatment of patients with infection secondary to obstructing stones.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"79-83"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}